Pitfalls of postoperative care following carotid artery surgery

Česká verzia

Authors: Michálek Pavel ^1,2; Stern Michael ³; Stříteský Martin ¹; Šedivý Petr ⁴
Authors place of work: Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. LF UK a Všeobecná fakultní nemocnice, Praha ¹; Department of Anaesthetics, Antrim Area Hospital, Antrim, United Kingdom ²; Anesteziologicko-resuscitační oddělení, Nemocnice Na Homolce, Praha ³; Oddělení cévní a rekonstrukční chirurgie, Nemocnice Na Homolce, Praha ⁴
Published in the journal: Anest. intenziv. Med., 22, 2011, č. 3, s. 153-158
Category: Přehledový článek

Summary

Carotid endarterectomy is one of the most frequent vascular surgery procedures worldwide. The postoperative course is mostly uncomplicated. Neurological complications may manifest as a cerebral stroke, hyperperfusion syndrome or, rarely, as convulsions. Postoperative cardiovascular instability that may occur includes hypertension or less often hypotension and cardiac dysrhythmias. Acute myocardial ischaemia is seen mostly in patients with ischaemic heart disease. Other complications include postoperative wound haematoma potentially leading to airway obstruction and damage to the nerves adjacent to the surgical incision.

Keywords:
carotid endarterectomy – cerebral stroke – hyperperfusion syndrome – acute myocardial infarction – airway obstruction

Zdroje

1. GALA trial collaborative group. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomized, controlled trial. Lancet, 2008, 372, p. 2132–2142.

2. Biller, J., Feinberg, F. M., Castaldo, J. E. et al. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Working Group of the Stroke Council, American Heart Association. Circulation, 1998, 97, 5, p. 501–509.

3. Michálek, P., Stern, M., Kubricht, V. et al. Anestezie v cévní chirurgii na začátku třetího tisíciletí. Anest. intenziv. Med., 2006, 17, 1, p. 21–29.

4. Roddy, S. P., Estes, J. M., Kwoun, M. O. et al. Factors predicting prolonged length of stay after carotid endarterectomy. J. Vasc. Surg., 2000, 32, 3, p. 550–554.

5. Kretz, B., Abello, N., Brenot, R. et al. The impact of renal insufficiency on the outcome of carotid surgery is influenced by the definition used. J. Vasc. Surg., 2010, 51, 1, p. 43–50.

6. Jordan, W. D., Alcocer, F., Wirthlin, D. J. et al. High-risk carotid endarterectomy: challenges for carotid stent protocol. J. Vasc. Surg., 2002, 35, 1, p. 16–22.

7. Debing, E., Aerden, D., Brande, P. V. Diabetes mellitus is a predictor for early adverse outcome after carotid endarterectomy. Vasc. Endovasc. Surg., 2011, 45, 1, p. 28–32.

8. Lee, J. W., Pomposelli, F., Park, K. W. Associations of sex with perioperative mortality and morbidity after carotid endarterectomy for asymptomatic carotid stenosis. J. Cardioth. Vasc. Anesth., 2003, 17, 1, p. 10–16.

9. Sarac, T. P., Hertzer, N. R., Mascha, E. J. et al. Gender as a primary predictor of outcome after carotid endarterectomy. J. Vasc. Surg., 2002, 35, 4, p. 748–753.

10. Girard, L. P., Feasby, T. E., Eliasziw, M. et al. Complication rates after left- versus right-sided carotid endarterectomy. Circ. Cardiovasc. Qual. Outcomes, 2009, 2, 6, p. 642–647.

11. McGrath, J. C., Wagner, W. H., Shabot, M. M. When is ICU care warranted after carotid endarterectomy? A three-year retrospective analysis. Am. Surg., 1996, 62, 10, p. 811–814.

12. Hertzer, N. R. Postoperative management and complications following carotid endarterectomy. In: Rutheford, R. B. Vascular surgery. WB Saunders: Philadelphia, 1995, p. 1637–1659.

13. Krul, J. M. J., van Gijn, J., Ackerstaff, R. G. et al. Site and pathogenesis of cerebral infarction associated with carotid endarterectomy. Stroke, 1989, 20, 3, p. 324–328.

14. Sheehan, M. K., Baker, W. H., Littooy, F. N. et al. Timing of postcarotid complications: a guide to safe discharge planning. J. Vasc. Surg., 2001, 34, 1, p. 13–16.

15. Hiramatsu, K., Shima, T., Toyota, A. Usefulness of ultrasonologic examinations on microemboli and hemodynamicks for the prevention of complications associated with carotid endarterectomy. J. Stroke Cerebrovasc. Dis., 2003, 12, 2, p. 51–58.

16. De Borst, G. J., Moll, F. J., van de Pavoordt, H. D. et al. Stroke from carotid endarterectomy: when and how to reduce perioperative stroke rate? Eur. J. Vasc. Endovasc. Surg., 2001, 21, 6, p. 484–489.

17. Pappada, G., Vergani, F., Parolin, M. et al. Early acute hemispheric stroke after carotid endarterectomy – pathogenesis and management. Acta Neurochir., 2010, 152, 4, p. 579–587.

18. Attigah, N., Kulkens, S., Ringleb, P. et al. Postoperative neurological deficit after carotid endarterectomy: a mid-term outcome analysis. Cerberovasc. Dis., 2010, 30, 3, p. 297–301.

19. Gupta, P. K., Pipinos, I. I., Miller, W. J. et al. A population-based study of risk factors for stroke after carotid endarterectomy using the ACS NSQIP database. J. Surg. Res., 2010, Epub ahead of print.

20. Nielsen, M. Y., Sillesen, H. H., Jorgensen, L. G. et al. The haemodynamic effect of carotid endarterectomy. Eur. J. Vasc. Endovasc. Surg., 2002, 24, 1, p. 53–58.

21. Mazul-Sunko, B., Hromatko, I., Tadimac, M. et al. Subclinical neurocognititve dysfunction after carotid endarterectomy – the impact of shunting. J. Neurosurg. Anesthesiol., 2010, 22, 3, p. 195–201.

22. Rerkasem, K., Rothwell, P. M. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Cochrane Database Syst. Rev., 2009, 4, CD000190.

23. Weber, C. H., Friedl, H., Hueppe, M. et al. Impact of general versus local anesthesia on early postoperative cognitive dysfunction following carotid endarterectomy: GALA study subgroup analysis. World J. Surg., 2009, 33, 7, p. 1526–1532.

24. Ouriel, K., Shortell, C. K., Illig, K. A. et al. Intracerebral hemorrhage after carotid endarterectomy: incidence, contribution to neurologic morbidity, and predictive factors. J. Vasc. Surg., 1999, 29, 1, p. 82–87.

25. Henderson, R. D., Phan, T. G., Piepgras, D. G. et al. Mechanisms of intracerebral hemorrhage after carotid endarterectomy. J. Neurosurg. 2001, 95, 6, p. 964–969.

26. Naylor, A. R., Evans, J., Thompson, M. M. et al. Seizures after carotid endarterectomy: hyperperfusion, dysautoregulation or hypertensive encephalopathy? Eur. J. Vasc. Endovasc. Surg., 2003, 26, 1, p. 39–44.

27. Noorani, A., Sadat, U., Gaunt, M. E. Cerebral hemodynamic changes following carotid endarterectomy: cerebral hyperperfusion syndrome. Expert Rev. Neurother., 2010, 10, 2, p. 217–223.

28. Jorgensen, L. G., Schroeder, T. V. Defective cerebrovascular autoregulation after carotid endarterectomy. Eur. J. Vasc. Endovasc. Surg., 1993, 7, 4, p. 370–379.

29. Ascher, E., Markevich, N., Schutzer, R. W. et al. Cerebral hyperperfusion syndrome after carotid endarterectomy: predictive factors and hemodynamic changes. J. Vasc. Surg., 2003, 37, 4, p. 769–777.

30. Bouri, S., Thapar, A., Shalhoub, J. et al. Hypertension and the postcarotid endarterectomy hyperperfusion syndrome. Eur. J. Vasc. Endovasc. Surg., 2010, Epub ahead of print.

31. Wilke, H. J. II, Ellis, J. E., McKinsey, J. F. Carotid endarterectomy: perioperative and anesthetic considerations. J. Cardiothorac. Vasc. Anesth., 1996, 10, 7, p. 928–949.

32. Hartsell, P. A., Calligaro, K. D., Syrek, J. R. et al. Postoperative blood pressure changes associated with cervical block versus general anesthesia following carotid endarterectomy. Ann. Vasc. Surg., 1999, 13, 1, p. 104–108.

33. Hakl, M., Michalek, P, Ševčík, P. et al. Regional anaesthesia for carotid endarterectomy: an audit over 10 years. Br. J. Anaesth., 2007, 99, 3, p. 415–420.

34. Bove, E. L., Fry, W. J., Gross, W. S., Stanley, J. C. Hypotension and hypertension as consequences of baroreceptor dysfunction following carotid endarterectomy. Surgery, 1979, 85, 6, p. 633–637.

35. Lehv, M. S., Salzman, E. W., Silen, W. Hypertension complicating carotid endarterectomy. Stroke, 1970, 1, 5, p. 307–313.

36. Mehta, M., Rahmani, O., Dietzek, A. M. et al. Eversion technique increases the risk for post-carotid endarterectomy hypertension. J. Vasc. Surg., 2001, 34, 5, p. 839–845.

37. Janoušek, L., Michálek, P., Adamec, M. et al. Srovnání everzní a klasické endarterektomie a. carotis interna. Čes. Slov. Neurol. Neurochir., 2003, 66, 3, p. 203–205.

38. Stoneham, M. D., Thompson, J. P. Arterial pressure management and carotid endarterectomy. Br. J. Anaesth., 2009, 102, 4, p. 442–452.

39. Kougias, P., Weakley, S. M., Yao, Q. et al. Arterial baroreceptors in the management of systemic hypertension. Med. Sci. Monit., 2010, 16, 1, p. RA1-8.

40. Gur, I., Katz, S. Baroreceptor failure syndrome after bilateral carotid body tumor surgery. Ann. Vasc. Surg., 2010, 24, 8, p. 1138 e–e3.

41. Fagerlund, M. J., Kahlin, J., Ebberyd, A. et al. The human carotid body: expression of oxygen sensing and signaling genes of relevance for anesthesia. Anesthesiology, 2010, 113, 6, p. 1270–1279.

42. Nawaz, I., Lord, R. S., Kelly, R. P. Myocardial ischaemia, infarction and cardiac-related death following carotid endarterectomy: risk assessment by thallium myocardial perfusion scan compared with clinical examination. Cardiovasc. Surg., 1996, 4, 5, p. 596–601.

43. Beard, J. D., Mountney, J., Wilkinson, J. M. et al. Prevention of postoperative wound haematomas and hyperperfusion following carotid endarterectomy. Eur. J. Vasc. Endovasc. Surg., 2001, 21, 6, p. 490–493.

44. Rosenbaum, A., Rizvi, A. Z, Alden, P. B. et al. Outcomes related to antiplatelet or anticoagulation use in patients undergoing carotid endarterectomy. Ann. Vasc. Surg., 2011, 25, 1, p. 25–31.

45. Payne, D. A., Twigg, M. W., Hayes, P. D. et al. Antiplatelet agents and risk factors for bleeding postcarotid endarterectomy. Ann. Vasc. Surg., 2010, 24, 7, p. 900–907.

46. Rerkasem, K., Rothwell, P. M. Patch angioplasty versus primary closure for carotid endarterectomy. Cochrane Database Syst. Rev., 2009, 4, CD000160.

47. Knight, B. C., Tait, W. F. Dacron patch infection following carotid endarterectomy: a systematic review of the literature. Eur. J. Vasc. Endovasc. Surg., 2009, 37, 2, p. 140–148.

48. Hebb, M. O., Heiserman, J. E., Forbes, K. P. et al. Perioperative ischemic complications of the brain after carotid endarterectomy. Neurosurgery, 2010, 67, 2, p. 286–293.

49. Hertzer, N. R., Feldman, B. J., Beven, E. G. et al. A prospective study of the incidence of injury to the cranial nerves during carotid endarterectomy. Surg. Gynaecol. Obstet., 1980, 151, 6, p. 781–784.

50. Bageant, T. E., Tondini, D., Lysons, D. Bilateral hypoglossal-nerve palsy following a second carotid endarterectomy. Anesthesiology, 1975, 43, 5, p. 595–596.

51. Munro, F. J., Makin, A. P., Reid, J. Airway problems after carotid endarterectomy. Br. J. Anaesth., 1996, 76, 1, p. 156–159.

52. Carmichael, F. J., McGuire, P., Wong, D. T. et al. Computed tomographic analysis of airway dimensions after carotid endarterectomy. Anesth. Analg., 1996, 83, 1, p. 12–17.

53. O’Sullivan, J. C., Wells, D. G., Wells, G. R. Difficult airway management with neck swelling after carotid endarterectomy. Anaesth. Int. Care, 1986, 14, 4, p. 460–464.